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Episode 173: Fears & Phobias

One question that I get asked quite often is "What's the difference between a fear and a phobia?"
In short, a fear of something is fairly rational, even if we might think that there's no need for us to fear it, the fear still makes some sense. If someone has a fear of public speaking that makes sense, although what they're probably fearing is rejection from their peers but it still makes sense.
Whereas a phobia is in some way irrational. Either because the thing itself cannot hurt you or because the effect the fear has on you controls other aspects of your life, so it's one thing to be a bit scared of a dog that's in front of you, but if there isn't a dog anywhere, but you're still feeling scared because there's the possibility of a dog, then that's a phobia. Having a fear of dogs doesn't stop people walking to work, but a phobia of dogs certainly could.
Sometimes though it's neither, quite often people will talk about their fear of spiders or frogs and actually it's not a fear as such, it's just a heightened sense of disgust. If you've ever been shown a picture of something and said "Urgh, no I can't look at that." And pulled a grimacing face, then you know the difference between fear and disgust. The thing is sometimes fear and disgust get mixed up and people think that they're scared of spiders because they can't go near them but quite often the issue is they don't like feeling disgusted and so therapy is structured slightly differently.
But if it is a fear or a phobia then where do they come from. Is it nature or nurture? I'm going to sit on the fence on that question, because like with many issues it does seem to be a bit of both.
I would say mostly learned behaviour through culture or experience but there is definitely going to be a genetic component to having heightened anxiety levels which make us prone to phobic responses, Even at birth you can test how sensitive someone is to surprises and loud noises. It's quite normal when doctors are making what's called the Apgar score when a baby is born, to test the surprise reflex of the newborn by clapping to surprise them. Some of the babies will almost roll their eyes at you like petulant child and hardly react, and others practically will jump off the table. So we can be born with a heightened sensitivity to stimuli but I'd say it takes experiences to switch the fears and phobias on.
So how do we deal with them? Well like I so often say the first place to do some work when dealing with anything to do with the fight or flight response is to learn some breathing exercises to bring down the feelings that fear and panic bring out in the body, the churning in the stomach that comes from the body pulling on blood to feed the muscles incase you need to fight for your life, the production of adrenaline that makes your heart race. Breathing exercises help with that because the reason for those feelings is because your body wants oxygen in the muscles, so when you give your body oxygen it helps to prevent the ongoing need for more that would create that panicky feeling. So breathe, its called diaphragmatic breathing because in pulling your diaphragm down as you breathe in by pushing your stomach out a little you can expand your lungs and make them more efficient. and it will seem weird at first pushing your stomach out on the in breath because you might be used to pulling your stomach in and puffing your chest out when you breathe in, but you want to get out of that habit as soon as you can.
Theres a video here where I talk about it in a little more detail. I'd recommend you watch it because once you're quite good at controlling your body this way you can feel more confident about changing the way you feel about your phobia.
We do this by using SUDS, the subjective unit of distress scale. On a scale of 1 to 10 with 10 being "I think I'm having a heart attack!" and 1 being bored. You give the response you have to the stimulus a number then using those. Breathing exercises you can bring that number down until it's more manageable. And the best way to do that is with what's called "Systematic Desensitisation." Or exposure therapy it can be called sometimes. Which means you start with something small and work your way up.
If your fear is of talking to people and you already know that having a conversation with a stranger in a bus queue is 8 or 9 out of 10 on the scale then you need to start lower down and find something that is around a 5 or 6. It might just be brief eye contact with the checkout assistant in the supermarket or maybe even using the tills with the assistants in the first place instead of the self checkout. If doing that is 5 or 6 out of 10 then do it again and again using those breathing exercises to bring it down a number or 2 as you practise.
Given enough repetition you might find that what was once a 6 soon becomes a 2 and you can move on to the next level and do something that last week would have been an 8 and too overwhelming, but now is only a 6. Before you know it you can say good morning to a stranger in the street that you accidentally made eye contact with and feel proud of yourself.
If you've got a phobia of something like spiders or blood then you can use images and videos to help desensitise you, you'll need some help with that probably and if you can find some online content that pokes your anxiety to a 5 or 6 then you can look at it every day and you will soon bring the number down to a 1 where watching the same videos or looking at the same photo becomes boring. When you've done this you'll need a "scarier" image to poke your anxiety and by looking at it again and again until the number drops you'll prove to yourself that you're in charge of your fears.
Throughout all of this process you probably need to do something about the thoughts in your head too. Because out of habit your brain could be saying things like "You cant go in a lift because you'll suffocate." So you need to acknowledge that that's how you feel and correct your thinking with "There are air vents in the lift, you can breathe." Thoughts lead onto emotions so if you can change your thinking you can eventually change the way you feel. Look for evidence that your thinking is wrong or that you're catastrophising. What would you say to a friend who had these bizarre exaggerations? You'd probably say something like "Don't mix up what's possible with what's probable. Everything you could think about is possible but what will probably happen is that you'll be fine."
Whether that's about phobias of dogs, flying or the number 13. Make sure you get into the habit of challenging your thoughts because anything you repeat often enough becomes second nature and that's what we're looking for here.